Amanda Wilde (Host): Welcome to the Kirby Connections Health podcast, where we help you nourish your wellness journey with Kirby Medical Center. I'm Amanda Wilde. On this episode, we'll talk about depression and anxiety in rural areas with Taylor Ferguson, Director of Integrated Behavioral Health at Kirby Medical Center.

Taylor, thank you so much for being here to share your expertise on this critical topic.

Taylor Ferguson, MSN, RN: Yeah. Thank you for having me.

Host: Taylor, from your perspective working in Central Illinois, what are the most common risk factors contributing to high rates of depression and anxiety in rural populations compared to urban communities?

Taylor Ferguson, MSN, RN: They can be similar to those in urban, but just a little bit more impactful because we have things like limited access to just mental health care. We live in more stretched out areas that increases travel times to get those services. Transportation can be a barrier. So then, that makes it hard to be compliant with appointments and things that come with that. And also, as a result of that, you can see an increase in isolation and loneliness because again, with having these barriers or what we call social determinants of health, that just then people will just stay home rather than going out and taking care of themselves.

And then, in smaller towns and rural areas, stigma is still a big thing to try to get through. You have the mentality of everybody knows everybody. So, there's, you know, concern about privacy and confidentiality because they just, you know, "Maybe I don't want that person to know that I'm getting healthcare services for counseling and for my mental health." So, they just don't do it then because it's such a stronghold that we still continue to see.

Host: So, stigma and limited access actually isolates people even more. So, how do you shape your programs to address that?

Taylor Ferguson, MSN, RN: Yeah. So, one of the biggest programs we have here is called Senior Life Solutions. And that was designed to target our older population, 60 to 65 and older, which kind of grew up at a time where we don't talk about emotions, we don't talk about our feelings. So, in the last four years of me being here, we've done a lot of community education, a lot of community outreach to educate that it's okay to get help. And it's okay to seek services. And we do this in a group therapy modality so that they're around other individuals who have gone through or are going through similar things so that they realize that they're not alone. And that has been a very impactful program here in our community.

Host: So, you are addressing the social stigma and cultural attitudes. Are there also socioeconomic or occupational stressors like farming pressures or job instability that seem to play a role in triggering or worsening mood disorders?

Taylor Ferguson, MSN, RN: Yes. I mean, all of the above. You know, much of the rural community, especially here in Monticello, is farming, is agriculture. And a lot of that, you know, is also now dependent on external factors, the weather, things that go along when it comes to farming, drought seasons, raining, things along those lines. So when we have a more wet season, that can impact the crops. If we have a more dry season, that impacts the crops, which then impacts, you know, financial strains. So, it's really kind of just all of the above. And then, of course, governmental policies can play a role in all of that, and all the fluctuations that come with that. So, a lot of those uncertainties can continue to persist as stressors and triggers that go unaddressed.

Host: And how much can lifestyle factors like physical activity or diet, sleep, substance use help or manage depression and anxiety in these communities?

Taylor Ferguson, MSN, RN: You know, the physical health and having a strong diet are always— you know, the recommended diet and rich fruits and vegetables and lean meats just kind of help promote a healthier overall wellbeing. And then, engaging in physical activities. You know, it doesn't have to be the strenuous things like CrossFit or marathon running or triathlons. But, you know, going for a walk, being out in your garden, just doing yard work or what we call like ADLs, just your daily living necessities just to kind of keep your body moving. But then, maybe integrating some little strength training. So, lifting weights maybe a little bit just to kind of keep up that muscle tone, but it doesn't have to be the most strenuous thing in the entire world.

Host: Right. I hear that. And I have read that even just spending a few minutes in the morning outside grounding yourself can make a huge difference and inspire you to do more of those self-care type of things.

Taylor Ferguson, MSN, RN: Yeah.

Host: Are there community-based programs, support groups, or faith or school-based initiatives that you've seen make a measurable difference for rural residents?

Taylor Ferguson, MSN, RN: You know, we continually work on that. One of the things that rural hospitals do are called community health needs assessments. And those are done about every three years in that, you know, we survey the community on what these needs are and how can we as a hospital organization and the community come together to help address these.

Some of the things, you know, that we have here to promote mental health, to promote physical health, you know, are like our primary cares. We have individualized therapy located in all the clinics. Of course, SeniorLife Solutions that I talked about. We do have our own KMC Move and KMC Active to kind of help promote that wellbeing. We have a wellness program for wellness coaching. And then, of course, we do a lot of work in the community. Over the last two years, I helped develop a health and wellness program for our local junior high seventh grade health classes that we co-teach. And we talk about just the basics of overall wellbeing using what's called the wellness wheel that integrated eight different dimensions of health.

And then, we couple that with basic kitchen sessions. So, I worked with our dieticians to then talk about just the basic how to be in the kitchen and things and cooking and just the basic necessities of that. So, that's been a fun little project, just to name a few things that we have going on.

Host: Yeah. So, rural healthcare systems can integrate with community systems or existing public health programs. Do you do that also for chronic diseases like cardiovascular conditions or diabetes, yes?

Taylor Ferguson, MSN, RN: Yeah. One of our subcommittees related to the CHNA, Community Health Needs Assessment, is targeting chronic diseases such as hypertension and diabetes, are the two big things that we are currently working on in that spectrum, because that came out to be the two biggest things that we are seeing amongst our county and community.

Host: And as we look at early detection for depression and anxiety in rural communities, is there a role there for AI or mobile apps that I've heard about?

Taylor Ferguson, MSN, RN: There's a lot of research out there. None of it's been like concrete, but you have things like the Calming app, which I talk to my patients about just to kind of help teach you or keep you in line with the things that you're learning in therapy to do the grounding techniques, do the mindfulness meditations, and things along those lines.

That's the biggest one I kind of talk about. I haven't really delved into many of them at this time. But I know that as, you know, we continue to advance, that technology is going to continue to grow. And I think there will be more alternatives for that.

Host: There's so much you're doing to support people suffering from depression and anxiety in your community. How can family members and caregivers in rural households be better educated to recognize early warning signs and provide supportive care?

Taylor Ferguson, MSN, RN: I think open-mindedness is a big thing. So, just being open to mental health, so kind of getting around that stigma and, you know, not being afraid to have those conversations.

One of the things that I work on with through our high school program called Pathways is it's okay to say words like depression. It's okay to say words like suicide. That you're not going to put that in their head. But you're going to open that conversation and you're going to provide a safe space and, you know, a judgment-free zone to have open conversation about things. So, just being open-minded, I think, is the biggest thing. You don't always have to know what to say back, but just being a listener can honestly do so much, more than some realize.

Host: So true. Listening. Very simple things, like you said, can really make big changes. Taylor, thank you so much for this in-depth look at recognizing and responding to depression and anxiety, and specifically shining a light on our rural communities.

Taylor Ferguson, MSN, RN: No, I am excited to be here today.

Host: For more information, visit kirbyhealth.org/services/mentalbehavioralhealth. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. This is Kirby Connections Health Podcast, presented by Kirby Medical Center.